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Refugees from

As of October 2014, the three-year conflict in Syria has displaced nearly CONTENTS 9.5 million people, more than 40% of the country’s pre-war population. Of these, over 3 million have found temporary asylum in the neighboring SYRIA PROFILE 2 countries of , , , , and . Only about 15% Modern History, of the Syrian refugees live in refugee camps. The rest live outside Government, and Economy 2 camps, in cities, towns, and rural areas, often in difficult circumstances Health Care and Education 3 and in locations not easily reached by humanitarian aid organizations. The Land 3 The great majority of the refugees are Sunni Muslim , but the The People 4 population also includes ethnic and religious minorities, such as Kurds, Beliefs and Customs 5 , and members of various Christian and Shiite Muslim sects. CONDITIONS IN FIRST- ASYLUM COUNTRIES 8 The influx has stretched to the breaking point the capacity of asylum countries to provide protection and assistance to the refugees. In an IMPLICATIONS FOR effort to relieve the pressure—and enable asylum countries to continue RESETTLEMENT 11 providing sanctuary to fleeing the war—the High SOURCES 14 Commissioner for Refugees (UNHCR) has asked resettlement countries to admit some of the refugees. As of October 2014, 24 countries, primarily in Europe and the Americas, have agreed to resettle Syrians. Above: A Syrian refugee family living in Jordan. Photo: UNHCR.

This backgrounder provides resettlement communities with basic information about Syrian refugees. A country profile provides a brief guide to Syria’s history, people, and cultures. The backgrounder then looks at the crisis in Syria and the conditions refugees face in first asylum countries. Finally, it considers some of the strengths and resources resettled refugees may be able to draw on in their new communities and some of the challenges they are likely to face.

The backgrounder is intended primarily for those providing initial support and assistance to the newcomers. Others may also find the backgrounder useful. Those who work in local government—health professionals, social workers, and housing officials, among others— may use it to better understand, and thus better serve, their new clients. Teachers may use the backgrounder to educate students about a people whose plight they may have read about or watched on TV. Readers may also include members of the general public interested in learning about their community’s newest residents. Refugees from Syria 2

Syria Profile who had written anti-government graffiti on a wall in Daraa. Perhaps inspired by the success of Arab Spring movements Modern History, Government, and Economy in Egypt and Tunisia, the protestors called for democratic Syria was part of the Ottoman Empire for 400 years, from reforms, the lifting of Emergency Law in place since 1963, the early 1500s to the early 1900s. A period of French the release of political prisoners, multiparty elections, and, colonial rule (1918-1946) ended with Syrian independence. on the part of some Syrians, the end of the regime. Utilizing The next 20 years saw multiple coups and a brief unity with informer networks, the Syrian government responded to Egypt as the . In 1963, the Ba’ath party the demonstrations as it had in the past, with widespread took over the government, installing a secular and socialist arrests, beatings by plainclothes government forces, brutal Arab regime. The new government purged dissenters, interrogations and torture, and the use of live ammunition nationalized banks, implemented land reform to give land to and snipers to terrify and kill street protestors. The people, peasants, and Arabized the educational curriculum. however, remained on the streets and began organizing in different ways against the regime. Since the start of the crisis, In 1970, the Minister of Defense, Hafez al-Assad, seized power, the Syrian government has referred to protesters and their and in 1971 made himself president. He created a legislative family members and sympathizers as terrorists. body, introduced a new constitution, and rigged elections that kept him in power and ensured Ba’ath party dominance. By June 2011, an estimated 1,400 people had been killed and The government cultivated close ties with the USSR, the over 10,000 arrested by the regime. That summer, the Free former Eastern Bloc, and Iran. Syria’s consumer needs were (FSA) was formed primarily by defectors from met through the development of various production sectors, the Syrian military, and the fighting to liberate Syria from the including agriculture, paper, cloth, and plastics. Higher Assad regime spread across the country. Islamist fighters education, including medical school, was in , and Syria joined the uprising. By 2013, over 1,000 individual brigades, became a lower middle income country with high levels of loosely organized into frequently changing networks, literacy, education, and employment. Assad belonged to the were fighting the Syrian government. Islamist extremists, Alawite sect of Islam, and his policies favored that sect and including factions based in Iraq, took advantage of the assured the allegiance of its members to him. Under the instability and joined in, fighting both the regime and the FSA Assad regime, dissent was harshly suppressed. at different times. One of the foreign factions, the militant Sunni group Islamic State, also known as the Islamic State In 2000, after 30 years of rule, Hafez al-Assad passed away of Iraq and Syria (ISIS), or the Islamic State of Iraq and the and was succeeded by his son, Bashar al-Assad, a British- (ISIL), established a base in eastern Syria. From there trained eye doctor who remains in power today. Under it launched an attack and takeover of western Iraq in 2014. Bashar al-Assad, authoritarian rule under one party and one ruler continued. Like his father, Assad favored the Alawite Involvement by outside parties has complicated the Syrian sect politically and economically and placed family members situation. The Syrian government has received economic in positions of power. Reforms lifted some of the restrictions and military support from Iran, Russia, and Hizbollah, the on freedom of the press and trade, benefitting a growing Lebanese Shi’a Muslim political/military group. Various urban business elite. Government support for education groups of opposition fighters have received assistance from and health care continued, with health care and higher regional Arab governments, and extremist Islamists have education provided at little or no cost. Alongside these free been aided by states and wealthy patrons in the region. The government-funded services, private universities and clinics moderate opposition has received some assistance from catering to the new elite were founded. Political repression Europe and the . and governmental corruption and mismanagement did not end, however, and most Syrians continued to feel oppressed Civilians and nonviolent activists have paid a heavy toll in by the Assad regime and Ba’ath party political control. the conflict. Since 2011, more than 191,000 people have been killed, and millions driven from their homes. Men, women, The 2011 uprising began as peaceful protests after the and children have suffered extreme trauma or witnessed government arrested—and reportedly tortured—schoolchildren it. It is estimated that half of Syria’s population is no longer

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living in their homes, with 6.5 million people internally level, especially among girls. At the post-secondary level, displaced in Syria, and 3 million registered as refugees in government support greatly expanded access to higher neighboring countries. education. But for many young Syrians the education they received did not meet labor market needs and as a result did Health Care and Education not lead to stable employment—a failure that has fueled much HEALTH CARE of the youth discontent, according to some Syria experts. In pre-conflict Syria, the government emphasized health care, but in a country with a high rate of population growth, A second major thrust of the government was universal funding could not keep up with demand or maintain quality. literacy. In the early 1980s, an estimated 42% of the Access to health care was uneven. For example, in population could not read or write. By the early 2000s, Syria’s in 2009, there was one doctor per 339 people, while in rural adult basic literacy rate had risen to over 90% for men and Al-Hassakah governorate, the ratio was one doctor per 1,906 over 77% for women, according to the CIA World Factbook. people, according to the World Health Organization. The conflict has taken a severe toll on the country’s school The current conflict has shattered the country’s health system. In 2013, UNICEF reported that many schools had care system, leaving many Syrians with little or no access been severely damaged or were being used by armed groups to basic medical care, including childhood immunizations. and displaced persons seeking shelter. School attendance By 2013, roughly half of the country’s health care facilities rates had plummeted—down to 6% in some areas. The had been destroyed or damaged, and most of Syria’s report cited insecurity, lack of teachers and resources, and health care professionals had fled or been killed or injured. damaged buildings as among the causes of the decline. As drug production fell, treatment for both chronic and critical illnesses became scarce, according to the Syrian The Land Humanitarian Assistance Response Plan (SHARP) 2014. GEOGRAPHY By targeting medical facilities and blocking humanitarian On the eastern end of the , Syria is medical aid, the Syrian government has prevented its citizens bordered by Turkey on the north, Israel and Lebanon on living in areas under the control of opposition forces from the west, Iraq on the east, and Jordan on the south. Syria receiving health care. is a medium-sized country, with a diverse geography. The western third of the country and areas of the north and The country’s dwindling mental health care capacity can meet the east are fertile agricultural land, part of an area known only a tiny fraction of the need. Before 2011, mental health since ancient times as “the .” The care was in short supply, with only two public psychiatric River flows from Turkey into northeastern Syria and then hospitals and 70 psychiatrists serving a population of 22 on to Iraq. The river creates vast areas of fertile farmland, million. Today, with more Syrians than ever before in need diminished in recent years by Turkish dams and scant of care, there are even fewer resources. The one psychiatric rain. Mountain ranges in the west next to Lebanon and in hospital still open is located on the outskirts of Damascus, the northwest next to Turkey receive snow in the winter. unreachable by those living in areas hardest hit by the conflict. Southeastern Syria is desert, while the western coastline on the Mediterranean has both beaches and an industrial port. EDUCATION In pre-conflict Syria, free public education for all became a All of these areas contain many important archaeological government goal. Post-secondary education was highly and historical sites, from pre-historic settlements (where one subsidized in an effort to meet the country’s development of the world’s first alphabets was invented) to vast Greco- needs. Roman ruins, early Christian monasteries and churches, Byzantine structures, Crusader castles, and 1,400 years of Success was mixed. On the one hand, high rates of primary Islamic-era architecture and infrastructure. The conflict has school attendance were achieved for both boys and girls. left its mark on the country’s ancient landmarks, however. On the other hand, primary school attendance in rural areas According to the American Association for the Advancement frequently remained far below the national average, and of Science, five of Syria’s six World Heritage Sites have in many places dropout rates were high at the secondary suffered significant damage.

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URBAN VS. RURAL conflict Syria, there were many small business owners as Syrians take great pride in their cities. Damascus, , well as a professional class made up of doctors, bureaucrats, , and Homs are the four largest. Each city has a long teachers, university professors, and social workers, among and storied history; Damascus, the country’s capital, has others. Syrians highly value the arts, and the work of its been called the oldest continuously inhabited city in the many musicians, writers, artists, and actors has been both world. Each of Syria’s major cities is built around an old promoted and controlled by the government. walled city, with Greco-Roman roads and markets, Jewish synagogues, numerous Christian churches, and some of the ETHNIC, LINGUISTIC, AND RELIGIOUS GROUPS world’s oldest Muslim mosques. Alongside these ancient Arabs, including Muslims and , make up nearly structures are private homes and public markets. Outside 90% of Syria’s population. Kurds, the second largest ethnic the walls, the cities expand into suburbs built in European group, make up about 10% of the population. There are other, colonial style, and then into modern suburbs, with large much smaller ethnic groups, such as the Armenians and the apartment buildings, universities, factories, shopping Turkomans. In Syria, ethnic identity and native tongue are centers, and hospitals. closely tied.

Syria’s rural areas contrast with the wealth of its cities. While All Syrians speak colloquial Arabic, and the great majority rural communities are the country’s breadbasket, the Syrian can also read and write in . The regime in the last 25 years has directed its resources toward Syrian dialect is closest to Lebanese/Palestinian/Jordanian urban areas and has not invested in rural development. dialects (known as Levantine or Shami Arabic), sharing with Government policy, as well as high levels of corruption and them a very similar grammar and vocabulary. Kurds from cronyism, has alienated rural communities and increased Syria and Syriac Christians speak Arabic as native or near- the divide between city and rural dwellers. As a result of native speakers and may know how to read and write it. In government neglect, rural people and migrants from the addition, Kurds may speak Kurdish, and Syriac Christians rural areas generally have lower levels of education. At the may speak Syriac. Armenians speak Armenian and are able same time, because they have had to rely on themselves, to speak colloquial Arabic, but may not know how to read rural people have more experience in community organizing. and write the language very well. The Turkomans speak a variation of Turkish; they also speak Arabic, but most do Government mismanagement during a seven-year drought not read and write it. Many resettled Syrians will have a from 2003 to 2010 forced hundreds of thousands of people basic knowledge of English, but only a small number will to leave their land and move to cities for their survival. This be proficient in the language. Some will also speak some mass migration caused high food prices and unemployment French, German, Russian, or another foreign language, in both rural and urban areas, leading to economic tensions depending on their schooling. that some allege contributed to the 2011 uprising. Syria has a history of religious tolerance and pluralism and The People is a much more secular society than many of its Muslim Syria is a culturally diverse country with a pre-conflict neighbors. Syria’s population is 90% Muslim (74% Sunni population of 22 million people. Its population is relatively Muslim and 16% Alawite, Druze, and Ismaili). Christians, well educated, and quite young, with a median age of 22. It comprising 10% of the population, include is estimated that almost 60% of Syrians lived in urban areas (Greek Orthodox and Catholic), Syriac Christians, - before the fighting caused massive displacement. speaking Christians, and Armenian Orthodox and Catholics. There is also a small Kurdish-speaking Yazidi community EDUCATIONAL AND OCCUPATIONAL BACKGROUNDS whose religion has been linked to Zoroastrianism and ancient Most Syrians have attended at least primary school and have Mesopotamian religions. A small Arabic-speaking Jewish basic literacy skills in Arabic. According to the World Bank, community left Syria in the 1990s. 72% of Syrians of secondary school age were enrolled in school before the uprising. Syrians are known in the Arab Although the war has fueled sectarian tensions, pre-conflict world as skilled in construction and other types of manual Syrians interacted with members of all religious and ethnic labor and in the hospitality and service sectors. In pre- groups at work, at school, and in their neighborhoods.

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However, because of governmental preference for Muslims think about ways to better themselves spiritually. and urban dwellers over the last 30 years, those living The end of Ramadan is celebrated with prayer and three in the largely Sunni countryside have felt politically and days of family visits and feasting, called Eid. Another economically excluded. Kurds and Turkomans are two important Muslim holiday commemorates the end of the rural-based minority groups that have been left out of the pilgrimage to Mecca (the hajj). growth and development of the state. The Kurds have also been neglected because of the government’s fear of Kurdish Devout Christians in Syria wear crosses around their necks political organizing for independence. and attend church regularly. Eastern Orthodox Christians also have fast days, including the 40 days of Lent, when they Syria has a long history of accepting immigrants and abstain from all animal products (meat, fish, milk, chocolate, refugees. Over the past 200 years, refugees, pilgrims, and butter, and so on), essentially becoming vegans. Unless they traders from Afghanistan, , Iran, Northern Africa, and are Catholic, Syrian Christians follow the Eastern Orthodox what are today and Sudan have become part of calendar. Catholics celebrate Christmas on December 25, Syrian communities. In recent years, Syria has given asylum while Eastern Orthodox Christians celebrate Christmas on to large numbers of refugees fleeing turmoil in the region. January 6 and 7. Western and Eastern churches also differ in Since the 1948 Arab-Israeli war and the creation of Israel, their observance of Easter, which is a much more important Syria has hosted more than 500,000 religious event than Christmas for Syrian Christians. in camps in the western part of the country. do not have Syrian citizenship, but have most other For both Muslims and Christians, holidays are celebrated not rights, including the right to education, health care, and only as religious occasions, but also as family and community employment. After the 2003 U.S. invasion of Iraq, hundreds affairs. Holidays are a time to visit relatives and neighbors of thousands of Iraqi refugees fled to Syria, and while many and wish them well—it is not uncommon to make as many as have returned to Iraq and others have fled to Jordan and 10 visits in a day. All Muslim and Christian holidays in Syria Turkey, some 28,000 remain in Syria, primarily in Damascus. are official holidays, and thus most Syrians know about these Syria also took in Lebanese refugees during the 2006 war two religions and their traditions. between Israel and Lebanon. CUSTOMS Beliefs and Customs Family and Family Relations RELIGIOUS BELIEFS Families are generally large and extended in Syria. They Syrians profess the faith they were born into, and conversion include not only parents and children but also grandparents, to another religion is rare. While religion is a part of a aunts, uncles, and cousins. Among family members, there Syrian’s identity, it is not necessarily a defining feature. Few are close bonds of love and support as well as responsibility Syrians are agnostics and fewer still atheists, yet many and supervision. Family members feel a duty to take care feel strongly that religion should be a private matter and of each other and make sure no one does anything that will separate from the government. Syrians may or may not be negatively affect other family members. Family reputation devout in their faith: Varying levels of religious belief and is as important as individual freedom. Improper behavior by practice are accepted, even within the same family. Joining women or the failure of men to live up to the code of honesty a religious community in the resettlement country may help and generosity can ruin the honor of the family. Syrians adapt, but they may not be comfortable with public expressions of faith outside of prayer. In general, Syrian society is patriarchal, and everyone is under the protection and authority of the oldest man. Devout Muslims in Syria pray five times a day, but do so Women are believed to be in need of protection, particularly in private, and they may postpone a prayer if it is not from the attention of unrelated men. Although older men are convenient to pray at the scheduled time. Before praying, the family decision makers, women and younger men engage they will need to cleanse themselves by washing their feet, in a great deal of negotiation and non-confrontational hands and forearms, and faces. Muslims fast for the lunar actions to achieve their own goals. month of Ramadan (with no eating, drinking, or from sunup to sundown) as a way to feel empathy for the As in other Arab societies, names in Syria reveal family poor. Ramadan is a time for charity and introspection, when relations. On a document, a child’s given name is his or her

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first name, and the second name (whether the child is male or female) is the father’s first name, while the last name is either the family name or the first name of the grandfather Women and Girls Face on the father’s side. A woman does not take her husband’s name in marriage. By Islamic law, any property or wealth Special Challenges that a man or woman brings to a marriage remains in that Syrian women and girls must grapple with the threat of person’s name alone, and does not become joint property. sexual violence in both Syria and the first asylum countries. Sexual violence and the threat of sexual violence in Syria Gender Roles and Relations caused many women and girls to flee the country. Talking Gender roles in Syria vary according to economic class, about the subject is socially unacceptable, however, and family, and urban/rural residency. In general, women cook, women are unlikely to raise or discuss the issue in front of clean, and care for children, taking great pride in well-kept male family members. homes, pressed clothes, and good food. Men are mainly responsible for working and financially supporting the In first asylum countries, the fear of sexual violence from entire family. Girls help with the housework, and boys may other refugees or host country nationals may cause refugee contribute to the family’s income by working odd delivery or women and girls to stay home, venturing outside—to go to agricultural jobs, although most children do not work until classes, appointments, or community events—only when they finish or quit school. The education of children is seen accompanied by other family members. as important, but children who do not do well in school may drop out to start work or get married. Poverty and fears for the safety of young girls have led some Syrian refugee families to arrange early marriages for their Among the upper and more educated classes, women work daughters. For example, in 2013, 25% of all marriages by Syr- outside the home, and can be found in a wide range of ian refugees in Jordan involved a female between the ages of professions, including medicine (at all levels), office work, 15 and 17. Many of these marriages have not been registered government service, education, laboratory work, computer with local authorities, and some may have ended in divorce. It science, and social work. Wealthier families support the is possible that a resettled female refugee teenager has been education and employment goals of both girls and boys, and divorced or has a child from an early marriage. are likely to hire women from outside the family to help with household chores and childcare.

In middle-class urban and rural households, fewer women one another, members of the opposite sex are likely to shake work outside the home, particularly if there are young hands, although devout Muslim women do not shake hands children, as mothers want and are expected to stay home with unrelated men. Instead, they may nod and put their and care for their children. These women generally have hands on their hearts. lower educational levels and less access to professional or skilled employment. Women in rural areas help out with Regardless of religion or social background, Syrian men and family work outside the house, in agriculture and subsistence women are quite affectionate with members of the same labor, in addition to their household chores. Poor women gender. It is very natural for two Syrian men or women to work in menial, low-wage jobs; such work is generally seen hold hands, lean on and touch each other, and greet each as demeaning and evidence that their husbands and families other with kisses on the cheeks. cannot provide for them. Religiously conservative families (both Muslim and Christian) place more emphasis on women Marriage staying home with children as a duty. Syrians tend to marry at a young age, with rural and working-class women generally marrying younger than More highly educated men and women (whether Muslim, women who are urban and/or more educated. By law, boys Christian, or non-religious Druze) socialize with one another. are eligible to marry at 18 and girls are eligible at 17, but the Conservative Muslim women from less educated families do minimum ages can be lowered to 15 for boys and 13 for girls, not socialize with men outside of their families. In greeting

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with the approval of a legal guardian. It is not uncommon for Under the two Assad regimes, community organizing was men to be 10 to 15 years older than their wives. considered a threat to the government. There were Ba’ath party officials whom people feared or worked with as In wealthier, more educated families, young women marry go-betweens with the government, and certain “elders” shortly after completing university, and men generally appointed by the government to represent the community. marry after they complete their education and have found For help with religious or personal issues, Syrians consulted regular employment. Children live with their parents until religious leaders. Charitable organizations, closely monitored they are married, and children who do not marry remain in by the government, assisted the disadvantaged. It was in their parents’ home. Before getting married, a young man is these organizations (such as the Syrian Arab Red Crescent expected to be able to support himself and his wife. with its vast network of volunteers) that young people learned organizing skills. While some young men and women choose their partners, most Syrian marriages are arranged by their families and The 2011 uprising saw the emergence of activists, leaders, are preceded by a formal engagement. An engagement and community organizers. They have organized under period allows people to get to know one another before extremely violent conditions, and often underground and marriage, and sometimes an engagement is even broken. in secrecy. The community leaders who have emerged in While legal, polygamy appears to be relatively uncommon: refugee areas have often been unelected and self-appointed. In a 2005 survey of 1,891 people, about 9% of urban men In many cases, they have risen into positions of leadership and 16% of rural men had more than one wife. Divorce through their connections to local landowners, foreign is rare among both Muslims and Christians, but it does language skills, or opportunism. In pre-2011 Syria, women had happen, and divorced women often receive child support. the opportunity to become leaders, particularly of charitable The religious court decides what happens to the children. organizations and structured groups, but they are likely to be In most cases, they stay with the mother until they reach sidelined in the post-2011 environment. 14 years of age or the mother remarries, at which point they go to live with the father. Health Care Beliefs and Practices PHYSICAL HEALTH CARE. Syrians highly value Western Parenting medicine, though their health care beliefs, practices, and Syrians parent closely, helping children with schoolwork and preferences reflect their own culture and social realities. monitoring all activities as best they can. Children in pre- conflict Syria were free to run around and play together in Syrians place great faith and trust in doctors. They often their neighborhoods or villages, which were seen as very seek immediate medical help for physical ailments and are safe spaces. Traditionally, girls who have passed puberty are usually anxious to begin medication as soon as possible. less likely to play outside and more likely to stay home or Syrians will answer their health providers’ questions, listen help with chores. If they do go out, they go with other girls carefully to their explanations and advice, and generally or older siblings. Boys often monitor the behavior of their follow instructions carefully. sisters, and older girls and sometimes boys help take care of younger siblings. While most Syrians have at least a basic familiarity with Western medicine, attitudes and expectations regarding Syrians are very affectionate with children—even the children health care may depart from mainstream Western norms. of strangers—and will hold them on their laps, tousle their Here are some common Syrian beliefs, practices, and heads, and kiss the cheeks of babies and children. Children preferences that may differ from those typically found in are expected to shake hands when they meet new people resettlement countries: and show respect for elders. Corporal punishment is common and accepted, and children will be disciplined with scolding >> Syrians generally prefer to be seen by same-sex and slaps to the face and hands (but not to the bottom). health care providers. In rural areas of Syria, women will choose the services of a midwife over those of a Leadership male gynecologist. Without a strong tradition of civil society organizing, >> Syrians may be embarrassed by personal questions, pre-conflict Syria did not have many community leaders. particularly those having to do with sex. Sexual problems

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and sexually transmitted diseases are sensitive issues as and . Baklava, made of filo pastry filled and should be approached with care. with chopped nuts and soaked in honey, is a popular dessert. >> For reasons of modesty, female hospital patients usually prefer long hospital gowns. Breakfast is usually tea or coffee with pita bread and either >> During hospital stays, observant Muslims will ask for cheese, eggs, , or yogurt and maybe jam and . food that is in accordance with Islamic dietary laws. Lunch, eaten around 2:00 to 3:00 p.m., is generally the During Ramadan, patients may refuse to eat or take largest meal of the day. It is often a cooked stew, ideally with medication during the day. meat or chicken and vegetables, commonly served with rice >> Syrian men and women consider it their responsibility and eaten with pita bread and salads. Dinner is usually late to take care of elderly or ill relatives and members of and similar to breakfast. their community. >> The presence and emotional support of family and Religious strictures impose dietary restrictions. Muslim friends is extremely important during illness. Syrians will not eat pork, and observant Muslims will not drink >> After symptoms disappear, patients often stop taking alcohol and may not eat shellfish. Alcohol is consumed by medication, and may not return for a scheduled follow-up. more secular Muslims and by Christians and non-religious >> Training to be a nurse is less rigorous in Syria than in Druze. Everyone drinks cups of tea and coffee throughout the Western countries. As a result, Syrians tend to have less day, served with lots of sugar. Smoking is common, including confidence in nurses than people in the West have. indoors in homes, offices, and restaurants. In Syria, women do not smoke in public, but might do so at home or in places MENTAL HEALTH CARE. Syrian attitudes toward mental health where there are no men present, such as public bathrooms. treatment have shifted since 2011. Before the crisis, most Syrians viewed mental illness as a stigma that brought Clothing shame on the family, and Syrians with mental health Syrians, regardless of background, tend to dress modestly needs were usually reluctant to seek professional help or in public. Shorts, for example, are never worn outside the discuss their concerns with family or friends. Today, with home, except by men when playing sports or at the beach. large numbers of men, women, and children in obvious psychological distress and need of care, Syrians are more That said, in clothing, as in other things, there is an urban- open to seeking mental health treatment. rural divide, with women in the cities likely to wear dresses, jeans, and other Western clothes. Pre-2011, most Syrian Food, Drink, and Smoking women and girls did not wear headscarves, but there has For Syrians, eating is an important social activity. Syrians been an increase in religious dress since 2011. value eating meals with family and friends. Inviting others to share one’s food is an essential courtesy; the person invited A devout Muslim woman will cover her legs, arms, and torso is expected to decline the invitation the first time, out of up to her collarbone and may wear a headscarf. Most Muslim politeness. Syrians will always offer a companion some of women over 65 also wear a headscarf, as a sign of age, if what they are eating or drinking, and men will always pay for not belief. Christian women wear a light cover on their heads a woman’s meal or tea. Men will fight over the check in a café in church. or restaurant, with the oldest or wealthiest person winning, although friends and colleagues take turns paying. It is Conditions in First-Asylum Countries considered poor manners to divide the check. As of August 2014, 3 million Syrian refugees have been registered in the first-asylum countries of Lebanon, Turkey, Accustomed to a wide variety of grains, meat, fruits and Jordan, Iraq, and Egypt. Conditions vary greatly, both vegetables, Syrians like diversity in their diet. Common by country and within countries. Although much of the Syrian food includes pita bread, hummus (chickpea dip), baba international attention and resources has been directed ghanoosh (eggplant spread), mahshe (stuffed grape leaves, at refugees who are living in camps, 85% of the region’s zucchini, and bell peppers), shawarma (gyro), and salads such Syrian refugees reside outside camps. Locations are diverse,

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spanning major cities, provincial towns, sprawling suburbs, and rural areas.

Camps for Syrian refugees exist in three countries: Iraq, Jordan, and Turkey. While all camps generally meet international standards, conditions differ considerably. Refugees who live outside of camps often lack access to adequate shelter, clean water, health care, schools, and income-generating opportunities.

The following is a country-by-country summary of the An informal settlement in the Bekaa Valley, Lebanon. Photo: UNHCR conditions refugees in the region face.

Lebanon UNICEF and its partners have launched informal educational Lebanon, the smallest of the first-asylum countries, hosts activities for out-of-school , but hundreds the largest number of Syrian refugees. With a population of thousands still do not have access to education. These of 4 million people, Lebanon has allowed more than 35% of out-of-school children are vulnerable to exploitation, such as the region’s 3 million Syrian refugees to cross into Lebanon child labor and early marriage. (increasing its own population by 25%). The influx has exerted enormous pressure on the economy and public Turkey services, and caused an alarming rise in tensions between According to Turkish government figures in mid-August 2014, Lebanese and refugees as the two groups compete for jobs more than 217,000 Syrians were living in 22 tent or container and local resources. camps in 10 provinces. These camps are reported to be safe and in good condition, with adequate housing, food, water, Until recently many Syrians faced an uncertain future in laundry and cooking facilities, and health services. Children Lebanon, but a new policy permits Syrians who entered the attend camp schools, which follow the Syrian curriculum and country illegally or overstayed their legal stay to settle their provide instruction in Arabic and Turkish. residency status. For Syrian Kurds and Palestinians, however, the situation remains precarious. Kurds enter Lebanon as However, the majority of Syrian refugees in Turkey live stateless persons without any Syrian identification or identity outside the camps, and for these refugees conditions documents and are thus forced to live in the country illegally. are difficult. According to unofficial estimates, 200,000 Some Palestinians from Syria have been turned back at the refugees are in Istanbul, 200,000 in Gaziantep, and 100,000 border or forcibly returned to Syria. in Izmir, living in overcrowded conditions with extremely poor facilities. As UNHCR is not the lead actor in providing Lebanon has no refugee camps for Syrians. Refugees are assistance in Turkey, lack of information about services dispersed throughout the country across 1,700 localities. available to refugees is a common challenge for Syrians who Adequate shelter remains the greatest challenge in the often do not know how or where to register for such services. humanitarian response, with refugees living in overcrowded For example, although Turkish hospitals have been directed apartments or houses, abandoned buildings and, by the government to provide free health care to registered increasingly, in informal tented settlements. Access to health Syrians, NGO fieldworkers report that hospitals either do not care and clean water and sanitation is also a challenge. know about the policy or ignore it. Instead, hospitals often charge refugees the same rate that they charge foreign Other concerns relate to employment and education. The visitors for their services. influx has had a significant impact on the local economy, raising prices and making it difficult for both Lebanese and The cost of living in Turkey is much higher than in Syria, refugees to find gainful employment. In Beirut, men work at and to make ends meet adults and children often work odd jobs, mainly as residential building caretakers and street or beg in the streets. Most children are not permitted to vendors. Syrian children are allowed to attend Lebanese attend Turkish schools. Some enroll in schools set up by the schools, but due to overcrowding fewer than 100,000 of Syrian community or funded by UNICEF, but the UN agency the nearly 400,000 refugee children are able to enroll.

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estimates that 73% of school-age children are not enrolled Iraq in school. Iraq is not only receiving large numbers of Syrian refugees, but over the last three years it has seen the return of many in Istanbul are said to face especially Iraqi refugees who had previously found asylum in Syria. difficult conditions. Unemployment among the Syrian Kurds Most of the Syrian refugees are Kurds who have relocated is high, and access to health care is spotty at best. Employed to in northern Iraq. Smaller numbers of refugees work long hours for little pay, mostly in textile Syrian refugees reside in Anbar province in the west and in workshops, catering, and construction. other provinces.

Jordan Almost half of the Syrian refugees in Iraq live in 12 refugee Jordan has five official Syrian refugee camps, in the northern camps across three governorates. Iraqi Kurdistan’s governorates of Jordan near the border with Syria. For every autonomous government gives Syrians residency permits one Syrian in a , however, another four live that also allow them to work. The permits allow for freedom outside a camp. of movement in Iraqi Kurdistan, and all refugees, whether they live in or out of camps, can move and seek work The largest camps in Jordan are Za’atri, housing without restriction. approximately 80,000 refugees, and Azraq, housing between 8,000 and 13,000. One additional camp and two Domiz is the largest refugee camp in Iraqi Kurdistan, with small converted transit centers house an additional 5,000 close to 80,000 refugees registered as residents. The refugees. Health care is available in clinics and hospitals development of the camp over the last three years has been in the largest camps. With hot, dry, and dusty conditions uneven. In older, more established parts of the camp, there in the summer and heavy rains in winter, humanitarian are streets lined with shops, cafés, and restaurants. In transit agencies have struggled to make the camps habitable. One and new areas, there are makeshift informal tented areas challenge has been providing adequate water, sanitation, and few sanitation services. A survey of camp residents and hygiene (WASH) facilities. In the congested Za’atri camp, revealed a mixed picture. A little over half of the residents WASH challenges include the cost of trucking water into the interviewed felt the camp was safe and nearly two-thirds camp and removing waste, tension between Syrians and the said they were able to access medical services. Only one- surrounding Jordanian community over public water usage, third of the respondents were gainfully employed. and the failure to meet refugees’ WASH needs or take into account their practices. Non-camp refugees live mostly in urban centers with little access to humanitarian assistance. Their residency permits For the hundreds of thousands of Syrian refugees in Jordan entitle them to free medical and educational services, but living outside camps, conditions are increasingly difficult, the Kurdistan Regional Government health and education according to a joint UNHCR and International Relief and infrastructure has been overwhelmed by the needs of the Development survey. The survey highlights the daily struggle Syrians and of the newly displaced Iraqis. A 2014 report by for survival of some 500,000 registered urban Syrian the Turkish think tank ORSAM notes three issues of concern refugees as they face rising prices and substandard and among non-camp refugees: unsafe housing, high rents, overcrowded housing. Refugees working without permission and low school attendance by children, who must work to risk being exploited by employers, being deported to Syria, contribute to their family’s income. The report also points or forced to live in a refugee camp. Low school attendance, out that while public attitudes toward the refugees remain due to transportation challenges, bullying, and overcrowded mostly positive, local resentment is rising, particularly among classrooms, is also an issue. the poor, who claim the Syrians are depriving them of jobs, burdening the school and health care systems, and causing Syrian Palestinians in Jordan are particularly vulnerable. higher rents. According to an August 2014 report by Rights Watch, Jordan has officially banned entry to Palestinians from Syria Egypt since January 2013 and has forcibly deported more than 100 Egypt hosts an estimated 300,000 Syrians, of whom some Palestinian men, women, and children who managed to enter 140,000 have registered as refugees with UNHCR. Egypt has the country since mid-2012. no refugee camps for Syrians. Refugees are scattered in urban

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neighborhoods, renting and sharing accommodations. Syrian school education and a basic ability to read and write their refugees generally have access to Egyptian public health and own language. Many will also bring useful social media skills. education services, but they face discrimination in accessing Syrians under the age of 30 tend to be very technology these services. According to UNHCR, more than 68% of Syrian savvy, using social media applications to communicate with children are not receiving formal education, although some friends and family, share information, and organize activities. attend informal schools run by the Syrian community. Syrians Even older Syrians have a basic knowledge of email and in Egypt, like many Egyptians, face difficult living conditions, Skype. These skills will help newcomers adjust to the including rising prices, scarce work opportunities, and safety widespread use of computers in Western countries, as well concerns due to political instability. Egyptian authorities often as facilitate community-building post-resettlement. view Syrians with suspicion, and have occasionally detained and deported Syrians and Palestinians from Syria caught Initial Resettlement Issues and Needs without proper documentation. CASEWORKERS AND INTERPRETERS In pairing a refugee with a caseworker, gender is likely to be The smuggling of migrants, refugees and asylum-seekers more important than ethnicity and language background. from North Africa to Europe is a growing protection concern. This is particularly true for women, who will usually prefer a An increasing number of Syrian refugees are entering Europe female caseworker. illegally from Egypt and Libya, risking their lives in dangerous boat trips across the Mediterranean. According to UNHCR, If a Syrian interpreter is not available, then a non-Syrian more than 21,000 Syrian refugees were smuggled into Arabic speaker (such as an Iraqi or Palestinian) can be used. southern Italy in 2013 from North Africa and the . As with caseworkers, an interpreter who is the same gender as the refugee is generally preferable, particularly in health Implications for Resettlement care situations.

Strengths and Resources For Kurdish refugees, an Arabic or Kurdish language Resettled Syrian refugees will find they have strengths and interpreter can be used. A Kurdish-speaking interpreter will resources they can draw on in their new communities. With need to know the same dialect of Kurdish (either Kurmanji or a long history of migrating to other countries in search of Sorani) spoken by the refugee. better lives, Syrians are known for their hard work ethic and entrepreneurial spirit. This spirit can be seen in first-asylum EMPLOYMENT, LANGUAGE STUDY, AND EDUCATION countries. In Jordan’s Za’atri Camp, for example, refugee- Many Syrians will be eager to work as soon as possible. owned businesses line the main street, and in southeast Those with backgrounds in white-collar occupations may Turkey, small Syrian shops have sprung up throughout be reluctant to accept manual labor jobs, however. A job major cities. placement that considers a person’s background—for example, by placing a former government worker in a cashier Established Syrian and other Arab communities in rather than a janitorial position—is more likely to succeed. resettlement countries will most likely be a source of comfort Professionally trained Syrians will be eager to return to their and support for Syrian newcomers. There is an organized professions and should be told as soon as possible about any and well-resourced Syrian-American community in the recertification process. United States, and many of its members have been very active in raising money and working to provide humanitarian Language classes will be a high priority for Syrians, since assistance inside Syria. In countries that have resettled Iraqi most will arrive with little or no proficiency in the language of refugees, Syrian newcomers may be able to draw upon the the resettlement country. Those who have studied a Roman support of a group with whom they share not only a common alphabet-based language (for example, French or German) language and culture but also a similar history of hardship. will learn to read and write another Roman alphabet-based language, such as English or Swedish, more easily than those Educational levels will vary greatly among Syrian who can read and write only Arabic. newcomers, but it is expected that most adults will arrive in their new communities with at least some elementary

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Most children will arrive with little or no ability to speak, that are near Arab-speaking communities can also read, or write English or any other Western language. Some reduce isolation as well as provide opportunities to share will have very limited previous schooling, and will need information and coping strategies. special support in subject matter areas as well as in the language of instruction. CROSS-CULTURAL ISSUES Resettled Syrians will find much to like and admire in their MENTAL HEALTH SUPPORT new communities. In the United States, for example, they The refugee population includes men, women, and children will appreciate American values of social justice, freedom, who have suffered torture and violence, including sexual equality, and hard work. At the same time, they will violence. Mental health care providers working in Jordan encounter a culture that is very different from their own in report high rates of children, some age five or younger, who many ways. The following briefly discusses some cultural have experienced torture or trauma—higher levels than differences that may cause confusion and conflict. previously seen in Middle East refugee populations. Almost every Syrian refugee will have lost family or friends in the war. RELATIONS BETWEEN MEN AND WOMEN. The open and friendly relations between men and women in resettlement Studies of refugee populations indicate high rates of post- countries will be a source of confusion and discomfort for traumatic stress disorder, particularly among children and Syrians. Newcomers will need to understand that while adolescents. Survivors of trauma should be identified as relations between men and women may appear easy and soon as possible so that culturally sensitive support can be relaxed, there are customs and in some countries laws provided. As already noted, Syrians seem to have become governing acceptable behavior and speech, particularly in less opposed to mental health treatment since the conflict. the workplace. Stigmas persist, however, and resettled Syrian refugees who need psychosocial support may not openly request it. DOMESTIC VIOLENCE. Domestic violence is not illegal in Syria, Female refugees may not want to talk about sexual abuse in where victims of spousal abuse have very limited legal front of their families; many may reveal abuse in a healthcare recourse. Due to the extraordinary pressures of life in Syria setting. Some Syrians may have received only drug therapy and in countries of first asylum, domestic violence may have and may be unfamiliar with other forms of treatment. occurred in families, either between spouses or between parents and children. Refugees will need to understand For treatment to succeed, respecting confidentiality and domestic violence laws in their new communities and building trust will be critically important. Syrians are likely resources available to them. to prefer individual over group therapy, where such support is available. An Arabic-speaking social worker who is the POLYGAMY. Although polygamy does not appear to be same gender as the patient can be extremely helpful in widely practiced in Syria, it is legal. Syrians will need to building a trusting therapist-patient relationship. A former understand laws regarding polygamy in countries where United Nations official who managed psychosocial projects they are resettled. for displaced Syrians suggests that therapists break the ice with a statement of empathy, such as: “We know what a SAME-SEX RELATIONS. Syrian men and women show public terrible situation it was over there and how much you went affection for members of the same gender. For example, through. We are here to help you feel better and start a men hold hands and greet one another with kisses on the new, healthy life.” cheeks. This behavior should not be understood to indicate sexual orientation. Syrians will need to understand Western SOCIAL SUPPORT attitudes and norms regarding displays of affection between Resettled refugees may experience feelings of isolation in members of the same gender. their new communities. For groups, such as the Syrians, who are not used to spending long periods of time alone, social Among Syrians, there is a general stigma against gays and isolation can be an unfamiliar and unsettling challenge. openly gay behavior. LGBTI individuals are likely to keep their Community centers and events that bring refugees together sexuality very private. can lessen the sense of loneliness. Housing placements

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PARENTING. Syrian parents often do not provide the same level of adult supervision that is the norm (and in some cases, the law) in many Western countries today. It is also Syrian Refugees’ Views of customary in Syria to discipline children physically. Syrians the Situation Back Home will need to understand the laws and customs regarding neglect and abuse in their new communities. Resettled Syrian refugees will be of different minds about the political situation back home. All will agree that the SHOWING AFFECTION FOR OTHER PEOPLE’S CHILDREN. In Syria, fighting has devastated Syria and come at an unacceptable it is considered completely normal for someone to walk up to cost to ordinary people. Beyond that, three views—pro-As- a stranger’s child, pick her up, kiss her on the cheek and give sad, anti-Assad, and ambivalent—are likely to be found her candy, and exclaim how cute she is. Syrians will need to among the refugees. Pro-Assad Syrians will support Assad know that in other countries this behavior may be considered either out of conviction, shared identity, or fear for family extremely inappropriate. members still in Syria. The anti-Assad group will include those who believe in political freedoms and/or abhor the COMMUNICATION STYLE. Syrians may communicate in a more brutality of the regime. The third group, those who are am- intense way than is the norm in the resettlement country. bivalent, will be made up of Syrians who were anti-Assad in They may stand closer to one another when they talk, speak the past but are now uncertain about the regime because of in louder voices, and use more gestures. Those not used to the rise of Islamist extremism and the destruction of Syria. this communication style may think that two Syrians are in These Syrians may feel that however bad life in Syria was a heated argument when in fact they are simply having a under Assad, things are worse now. normal conversation. The political views that resettled Syrians bring with them Syrians exchange more niceties in conversations than may may spark intense discussion and friction among some. be common in resettlement countries. It is an everyday Other Syrians may have been conditioned by the crisis to courtesy to inquire about another’s health, even when the keep their political views private. Those working with Syrians people are not well acquainted. should respect people’s views and not probe or share them with others. HEALTH CARE PRACTICES. Syrians are used to medical care that reflects their religious and cultural preferences. Medical treatment is more likely to be effective when health professionals provide culturally sensitive care, such as revealing-clothing styles of Western women, particularly same-sex health care providers, long gowns that cover lower in summer. legs, and hospital food that follows Islamic dietary laws. It is essential that reproductive health care be provided to While Syrians often wear the same clothes two or three refugee women by female gynecologists and nurses. days in a row, they tend to wear only their nicest clothes in public, and the clothes are always clean and neatly pressed. SMOKING. In Syria, smoking is common, including indoors Newly resettled refugees will want access to an iron and in homes, offices, and restaurants. Syrians will need ironing board. to understand local laws, expectations, and etiquette regarding smoking in public places, at home, and in other RESTAURANT BILL ETIQUETTE. Syrians do not divide up a check people’s homes. in a restaurant. Instead, one person—usually the oldest or wealthiest male—pays the entire check. Syrians will need to CLOTHING. Syrian women generally dress much more understand the custom of splitting the bill in countries where conservatively than Western women, and many Muslim that practice is common. women use a headscarf to cover their hair. Syrians will be taken aback by the casual—and by Syrian standards,

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PROJECT MANAGER United Nations High Commissioner for Refugees. (2014, Colleen Mahar-Piersma August 13). UNHCR Turkey Syrian refugee daily sitrep. Retrieved from ReliefWeb Web site: http://reliefweb.int/ EDITOR report/turkey/unhcr-turkey-syrian-refugee-daily-sitrep- Donald A. Ranard 13-august-2014

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REVIEWERS Wedeen, L. (1999). Ambiguities of domination: Politics, Adrienne Fricke, JD rhetoric, and symbols in contemporary Syria. Chicago, IL: Syria Advisor University of Chicago Press. Physicians for Human Rights Yazbek, S. (2012). A woman in the crossfire: Diaries of the Suzanne Akhras Syrian revolution. London, UK: Haus. Resettlement Coordinator Syrian American Medical Society and Founder, Syrian Resource Network

© 2014 Center for Applied Linguistics

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November 2014